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Twenty Years of Disease-Modifying Anti-IBD Drug Use Preceding Colectomy for Refractory IBD-Associated Colitis
Olivia Ziegler1, Caroline J Soderman2, Alicia C Greene1
1Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
Diseases of the Colon and Rectum
|May 20, 2025
Summary
Patients with inflammatory bowel disease (IBD) undergoing colectomy are using more medications, but these disease-modifying anti-inflammatory drugs do not significantly delay surgery. Increased use of these IBD drugs does not appear to postpone colectomy for refractory disease.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Disease-modifying anti-inflammatory bowel disease drugs (DMAIDs) have advanced IBD treatment.
- Despite DMAID availability, many IBD patients still need colectomy.
- The effectiveness of DMAIDs in delaying colectomy is limited.
Purpose of the Study:
- To evaluate the patterns of DMAID use in patients with refractory IBD before colectomy.
- To determine if DMAID use influences the timing of colectomy.
Main Methods:
- Retrospective analysis of institutional data from an academic tertiary medical center (2003-2022).
- Included patients with Crohn's disease or ulcerative colitis who underwent colectomy for medically refractory disease.
- Assessed the number and type of DMAIDs used prior to colectomy and trends over time.
Main Results:
- 487 patients met inclusion criteria; most had ulcerative colitis (77.8%) and were male (57.1%).
- No significant difference in time to colectomy was observed between anti-TNF and non-anti-TNF initiators.
- Each decade saw an increase in DMAID use (approx. 1.5 additional drugs), but each additional DMAID did not significantly increase time to colectomy.
Conclusions:
- Patients with IBD-associated colitis requiring colectomy received increasing numbers of DMAIDs over 20 years.
- Additional DMAIDs did not significantly delay colectomy, nor did the initial choice of non-anti-TNF agents.
- A subset of patients use multiple DMAIDs without meaningful delay in colectomy.
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